TY - JOUR T1 - Can diaphragmatic ultrasound be used to predict extubation failure? JF - Archives of Disease in Childhood JO - Arch Dis Child DO - 10.1136/archdischild-2021-322812 SP - archdischild-2021-322812 AU - Simon Jackson AU - Julie Richardson Y1 - 2021/11/07 UR - http://adc.bmj.com/content/early/2021/11/07/archdischild-2021-322812.abstract N2 - An 8-year-old boy, with a medical history of congenital myotonic dystrophy (CMD) and scoliosis, was admitted to the paediatric intensive care unit (PICU) with a lower respiratory tract infection. He was intubated and received antibiotics. After a prolonged intubation, he tolerated a spontaneous breathing trial (SBT) and received ‘pre-extubation steroids’. He was extubated to non-invasive ventilation (NIV), but quickly was re-intubated. The reason for extubation failure was determined to be secondary to respiratory muscle insufficiency. Would diaphragmatic ultrasound (DU) assessment of function have predicted extubation failure?In an 8-year-old boy with CMD, can DU (intervention) be used to predict extubation failure (outcome)?This search was undertaken using PubMed (MeSH) and SumSearch. The descriptive terms of ‘diaphragm’, ‘ultrasound’, ‘mechanical ventilation’ and ‘paediatric’ were combined and generated 56 ‘hits’, of which 6 were relevant. The excluded hits occurred for the following reasons:Duplicates: 4Preterm: 2Not relevant: 38No abstract: 3Not English language: 2A summary of the selected articles is provided in table 1.View this table:In this windowIn a new windowTable 1 Articles included in assessment16–21The decision to extubate should be cautiously and judiciously undertaken. Extubation from positive pressure mechanical ventilation (MV) to negative pressure patient ventilation results in physiological changes for the patient. A recent paediatric study demonstrated 8.3% of mechanically ventilated patients had extubation failure within 48 hours.1 Desirable criteria for extubation include intact airway reflexes, … ER -